Individual
DR. JESSICA FAYE SIRAK-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
80 BAYLOR DR STE 104, BLUFFTON, SC 29910-8903
(843) 706-3022
Mailing address
80 BAYLOR DR STE 104, BLUFFTON, SC 29910-8903
(843) 706-3022
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1260
SC
152W00000X
Optometrist
2053
GA
152W00000X
Optometrist
OEG000195
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
920135949A
—
GA
01
—
DA9560
MEDICAID, GROUP
SC
05
—
DG2053
—
SC
01
—
SC2493E499
MEDICARE
SC
Enumeration date
05/05/2006
Last updated
05/01/2020
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